It is a popular notion that personality traits may influence the state of a
person's physical health. The image of the stressed, aggressive businessman being
liable to have a heart attack is so common as to have become a cliché, yet, as we
shall see, it has little evidential basis. If personality traits do influence health, then
this is one of the prime reasons to measure personality traits in medical settings.
However, there are difficulties in establishing the true nature of the relationship
between personality and health, including measurement, the distinction between
subjectively reported symptoms and objective signs of illness, and the direction of
causation. In addition, it is virtually impossible to assess the amount of risk that
personality traits pose on their own–the separate impact they might have over and
above that of poverty or working conditions, for example. The best solution is to
try to design studies and use statistical analyses that are appropriate to the study
of complex interactions. In this chapter we first discuss models of personality and
health, then go on to describe more specific areas such as personality, stress and
heart disease. Finally, we briefly discuss the connection between personality
and clinically defined 'psychosomatic' disorders such as irritable bowel syndrome
and globus pharyngis.

Models of the association between personality and health

We begin by reviewing possible causal relationships between personality and
health. Figure 10.1 shows four of the main ways in which health status and personality
might be linked (Suls and Rittenhouse, 1990; Smith and Williams, 1992).
The first possibility makes the strongest assumptions about the importance of personality
traits; traits may represent biologically based differences that partly cause
different illness outcomes. For instance, if neuroticism represents differentially
sensitive autonomic responsivity, as discussed in chapter 9, then one might expect
disorders such as hypertension, which are under autonomic control, to be related to
neuroticism differences. Second, the relationship between traits and illness might
be correlational rather than causal; for instance, the same biological processes
might underlie traits and illness outcomes without either being causally related to
the other. Perhaps, for instance, a particular gene makes someone susceptible to

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